Leadership may be in charge of driving home the point that patient experience is core to the strategy at Cleveland Clinic, but Merlino is also quick to point out that it is a shared responsibility among every employee. He says he learned early on in Cleveland Clinic's patient experience journey that aligning staff was central to carrying out his vision of putting patients first. When a 43-year old patient, who was getting ready to leave after an uncomplicated surgery, showed Merlino the journal she'd kept while at the hospital, he was shocked to see how many different people had helped care for her during the five days since when was admitted.

"At the end of this hospital stay, eight physicians had signed the journal, 60 nurses, and so many other people … and she forgot to have three people sign the journal," he says. "What it said to me, in a very, critical stage of this career, was that it's not just the doctor or the nurse, it's everybody. If everybody's not aligned in thinking what we're doing and how they're interfacing with that human being, then we're not going to be successful at delivering what we're supposed to be doing, which is high-quality care."

Merlino believes communication is the fundamental building block of a patient experience that, if it is positive, will have a ripple effect in hospital safety, quality, experience, and value. The multipronged approach defines the Cleveland Clinic's "Patients First" initiative, a personal mission for Merlino, who says helping patients have a good experience is beyond "more smiling" by physicians or gimmicks that attempt to make a patient happier. To Merlino, high quality and safety flow from solid communication with everyone involved in the healthcare of a patient.